Tuesday, October 13, 2009

Model Health Care System Drops Medicaid Patients

So let me get this straight. The government sets the rates for the poor and disadvantaged and one of the President's model health care systems balks? How's this going to work when the government runs more and more of the health care delivery in the US?

I took a look at the WAPO link - and the comments about it. Reminded me of something Frank Langone (founder of Home Depot) said on CNBC this morning. That the up and coming generation is - for the first time - dumber than the generation that came before it. And "dumb and dumber" was the general nature of the comments.

For example - people don't have any concept of Medicare (in terms of paying in when you're working and what you pay when you're on it). Paying for Medicare separately as part of FICA started relatively recently. And current recipients are 100% subsidized on part A - and up to 75% subsidized on part B (depending on income - minimum payment is about $100/month - and a married couple doesn't have to pay more per person unless MAGI exceeds $170k/year). The subsidy comes from the Medicare part of FICA - which is inadequate - which is why Medicare is now scheduled to go broke in about 2017. And Medicare doesn't cover everything - you need a Medigap policy too - unless you want to take risks like running out of hospital days. That will cost about $300/month to "plug the gap". Perhaps part D coverage too - at a cost of about $30/month. So - even with huge subsidies - a Medicare recipient will pay over $400/month - close to $5,000 year for Medicare. If you're married - that's about $10k more or less a year. For some reason - the WAPO readers think it costs a heck of a lot less.

Also - Mayo JAX and Scottsdale have never accepted Medicaid. All of the main Mayo facilities (which don't do primary care) accept Medicare patients - but do not accept Medicare assignment. For some reason - even though they wind up doing less paperwork as a result of this policy - they get paid about 15% more from Medicare. I have never understood the rationale behind this payment scheme (designed by Medicare - not Mayo). Perhaps someone can explain it to me.

I asked each of my three doctors (primary care, psychologist, psychiatrist) once on their feelings about the health care system. I felt what I got back was pretty interesting.

All three of them love Medicare. Medicare pays well and doesn't jerk them around too much. MedicAID, on the other hand... doesn't. I'm not shocked that doctors would refuse to accept it. I read one story where a doc lost money out of pocket on every tonsillectomy he did for Medicaid patients. If you pay less than the procedure is worth, why would any sane doctor accept your "insurance"?

Medicaid should probably die and be replaced with a public option that involves co-pays, co-insurance, and deductibles. The more truly poor you are, the less these amounts will be, but NEVER let them be zero unless you want people calling ambulances at 3am to go to the ER for a pregnancy test.

True story. Taxpayers paid cost for transport and ER time. The "patient" paid nothing. When something is free to use, there's no disincentive. Medicaid needs to stop being free to use. Then the program might have more money and doctors might start accepting it again.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.